ACS outlines progress and challenges in childhood cancer

A new report from the American Cancer Society (ACS) outlines the progress made, and—more importantly—the challenges that remain, in fighting childhood cancer. The report estimates the number of new cancer cases and deaths for children and adolescents in the United States; summarizes the most recent and comprehensive data on cancer incidence, mortality, and survival; and outlines what is known and where answers are still needed for childhood cancers.

The report, published in CA: A Cancer Journal for Clinicians (2014; doi:10.3322/caac.21219), calls the diagnosis of cancer in children and adolescents "a life-altering event for [children and adolescents] as well as their families." It points out that, although advances in the treatment of childhood cancer have saved many lives over recent decades, less progress has been made in understanding the causes and prevention of childhood and adolescent cancers.

Although there have been substantial improvements in survival for many childhood cancers, some have seen little progress. For example, progress against central nervous system cancers has been significant overall, but survival times remain tragically low for some subtypes. For diffuse intrinsic pontine glioma, the median survival time after diagnosis remains less than 1 year.

The report says, in 2014, an estimated 15,780 new cases of cancer will be diagnosed and 1,960 deaths will occur among children and adolescents age birth to 19 years. Annual incidence of cancer from birth to 19 years is 18.8 per 100,000; cancer will be diagnosed in approximately 1 in 285 children before age 20 years. Today, about 1 in 530 young adults between ages 20 years and 39 years is a childhood cancer survivor.

Among the issues outlined in the report that need to be addressed the fact that, while advances in survival for many types of malignancies have resulted from advances in surgical techniques, children treated for many cancers have a high risk of long-term health issues from the delivery of radiation therapy and use of chemotherapy. For example, children treated for brain tumors may experience seizures, weakness in the arms and legs, blindness, hearing loss, and such neuroendocrine effects as growth hormone deficiency, hypothyroidism, abnormal timing of menarche, and neurocognitive deficits.

Unlike adult cancers, only a relatively small percentage of all childhood cancers have known preventable causes. Early detection of cancer in children is much more difficult because some symptoms are similar to those of more common childhood diseases. Some symptoms of childhood cancer that should alert parents and health care providers include an unusual mass or swelling; unexplained pallor or loss of energy; a sudden tendency to bruise; a persistent, localized pain or limping; a prolonged, unexplained fever or illness; frequent headaches, often with vomiting; sudden changes in vision; and excessive, rapid weight loss.

"Progress in childhood cancer has been dramatic for some sites, but we cannot let that blind us from the fact that progress has been disappointingly slow for other sites, and that cancer remains the second leading cause of death in children," said Otis W. Brawley, MD, American Cancer Society chief medical officer.